Maeda Yuki, Kakuta Nami, Kasai Asuka, Yonezawa Hiroki, Kawanishi Ryosuke, Tanaka Katsuya
Department of Anesthesiology, Tokushima University, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan.
Division of Surgical Center, Tokushima University Hospital, Tokushima, Japan.
JA Clin Rep. 2024 Mar 4;10(1):17. doi: 10.1186/s40981-024-00700-9.
Patients with Eisenmenger syndrome (ES) requiring noncardiac surgery are at a significantly high risk of perioperative morbidity and mortality. However, perioperative management of patients with ES requiring laparoscopic surgery remains unclear.
We describe the case of a patient with ES who underwent laparoscopic hysterectomy under general anesthesia with a peripheral nerve block. The objectives of the perioperative management included the following: (1) maintaining systemic vascular resistance and cardiac output through euvolemia, facilitated by the infusion of noradrenaline, and (2) preventing a reduction in oxygen-carrying capacity and factors that elevate pulmonary vascular resistance, such as pain, hypoxia, and decreased body temperature. Although laparoscopic procedures involved an increased risk in patients with ES, they are less invasive than open surgeries.
This report describes the successful anesthetic management of a patient with ES, ensuring a balance between systemic and pulmonary vascular resistance.
患有艾森曼格综合征（ES）且需要进行非心脏手术的患者围手术期发病率和死亡率显著较高。然而，ES患者行腹腔镜手术的围手术期管理仍不明确。
我们描述了1例ES患者在全身麻醉联合外周神经阻滞下行腹腔镜子宫切除术的病例。围手术期管理目标如下：（1）通过等容状态维持体循环血管阻力和心输出量，必要时输注去甲肾上腺素；（2）防止氧携带能力降低以及防止疼痛、缺氧和体温降低等导致肺血管阻力升高的因素。尽管腹腔镜手术对ES患者来说风险增加，但比开放手术的侵入性小。
本报告描述了对1例ES患者成功的麻醉管理，确保了体循环和肺循环血管阻力之间的平衡。
